Renal Function Change in Hypertensive Members of the Multiple Risk Factor Intervention Trial

Abstract

Effective blood pressure control was associated with stable or improving renal function in nonblacks but not in blacks. These findings emphasize the importance of blood pressure control to maintain adequate renal function in hypertensive white men and raise important questions about the relationship of pressure reduction and renal function change in blacks.

Hypertension in black South Africans

“…The Multiple Risk Factor Intervention Trial (MRFIT) study demonstrated that black people had a higher serum creatinine level for the same level of BP than white subjects. 34 From the therapeutic perspective it is important to consider drugs that reduce renal vascular resistance and glomerular pressure such as calcium channel blockers (CCB).…”

Improvement of Blood Pressure Control in Hypertensive Patients with Renal Diseases

“…Hypertension in chronic kidney disease increases the risk of serious adverse outcomes, including renal failure, early development and accelerated progression of cardiovascular disease, and premature death (1)(2)(3). A number of randomized controlled trials have shown that antihypertensive treatment reduces cardiovascular mortality and morbidity and slows the progression of renal diseases (RD) (4)(5)(6). Furthermore, there is evidence that the benefit achieved is related to the extent to which blood pressure (BP) is lowered (1,(4)(5)(6)(7).…”

Does treatment of non-malignant hypertension reduce the incidence of renal dysfunction? A meta-analysis of 10 randomised, controlled trials

“…11 In a subgroup analysis of 5524 MRFIT enrollees, despite a 5-mm Hg difference in diastolic blood pressure between those receiving usual care and special intervention, reciprocal creatinine slopes over 6 years in the two groups were the same. 22 Randomised controlled trials using only antihypertensive medications, however, provide the most direct and unbiased study design to address whether treatment of hypertension reduces the incidence of renal dysfunction among patients with non-malignant hypertension. Patients with diagnosed and undiagnosed renal disease should be evenly distributed in the treatment and the control group so that confounding from this important source is eliminated.…”

“…This was hypothesised a priori to be a possible source of heterogeneity among studies, as black subjects are believed to be particularly susceptible to renal damage from hypertension. 21,22 Information on whether and how patients with renal disease were excluded from entry into each trial was abstracted. Also noted was how new cases of renal dysfunction were defined in the paper presenting the main findings of each trial.…”